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19
Case 1:07-cv-04672-CPS-MDG Document 73 Filed 07/02/2009 Page 1 of 1 LEVY DAVIS & MAIiER, LLP Jonathan A. Bernstein (JB 4053) Attorneys for Plaintiff 29 Broadway, Ninth Floor New York, New York 10006 (212) 371-0033 UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK CLAUDIA GAYLE, Individually, On Behalf of All Others Similarly Situated and as Class Representative, Plaintiff, - against - HARRY'S NURSES REGISTRY, INC., and HARRY DORVILIER a/k/a HARRY DORVILIEN, Defendants. 07 Civ, 4672 (CPS) (MDG) CONSENT TO JOIN COLLECTIVE ACTION TfflS FORM MUST BE RETURNED TO PLAINTIFFS' ATTORNEYS AT THE ABOVE ADDRESS nr.JULY 15. 2009 T0: Clerk of the Court Eastern District of New York 225 Cadman Plaza East Brooklyn, New York 11201 I was employed by Harry's Nurses Registry, Inc. and/or Harry Dorvilier on or after November 7, 2004. I understand this suit is being brought under the Federal Fair Labor Standards Act for unpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by Levy Davis & Maher, LLP (retainer agreement on file at the above address) and to be bound by any settlement of this action or adjudication of the Court. I declare under penalty of perjury that the foregoing is true and correct. Si^ature / ^ , Date Printed Name

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Page 1: Si^ature - harryhomecare.comharryhomecare.com/wp-content/uploads/2019/03/... · -^vf\ O CLc5 ^ "Qbs.CvX-'z FRANK M. PELLICCIONE Notary Public, State of New York Registration #01PE6068770

Case 1:07-cv-04672-CPS-MDG Document 73 Filed 07/02/2009 Page 1 of 1

LEVY DAVIS & MAIiER, LLPJonathan A. Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, New York 10006(212) 371-0033

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

Plaintiff,

- against -

HARRY'S NURSES REGISTRY, INC., and

HARRY DORVILIER a/k/a HARRY

DORVILIEN,

Defendants.

07 Civ, 4672 (CPS) (MDG)

CONSENT TO JOIN

COLLECTIVE ACTION

TfflS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS nr.JULY 15. 2009

T0: Clerk of the Court

Eastern District of New York

225 Cadman Plaza East

Brooklyn, New York 11201

I was employed by Harry's Nurses Registry, Inc. and/or Harry Dorvilier on or after November7, 2004. I understand this suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by LevyDavis & Maher, LLP (retainer agreement on file at the above address) and to be bound by anysettlement of this action or adjudication of the Court.

I declare under penalty of perjury that the foregoing is true and correct.

Si^ature / ^ , Date

Printed Name

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Case 1:07-cv-04672-CPS-MDG^ Document 79 Filed 07/17/09 Page 3 of 3

LEVY DAVIS & MAHER, LLPJonathan A, Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, Nev • York 10006(212)371-0033

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF NEW YORK *

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

Piainliff-

■ against -

HARRY'S NURSES REGISTRY, INC., and

HARRY DORVILIER adc/a HARRY

DORVILIEN,

Defendants.

07 Civ. 4672 (CPS) (MDG)

CONSENT TO JOIN

COTJ.ECI IVE ACITON

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS BY JULY 15, 2009

To: Clerk of the Court

Eastern District of New York

225 Cadraair Plaza East

Brooklyn, New York 11201

I was employed by Harry' s Nurses Registry, Inc. and/or Hany Dorvilier on or after November7, 2004. I understarrd this suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime, I consent to become a party plaintiff to this lawsuit, to be represented by Le\'yDavis & Maher, LLP (retainer agreement on file at the above address) and to be bound by anysettlement of tl action or adjudication of the C "un.

I declare under penalty of peijury that the foregoing is true and correct.

7/

Signature

AmIKm f/e'Ap/./t-mPrinted Name?

Date y

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Case 1:07-cv-04672-CPS-MDG Document 79 Filed 07/17/09 Page 2 of 3

LEVY DAVIS & MAKER, LLPJonathan A. Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, New York 10006

(212)371-0033

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

Plaintiff,

- against -

HARRY'S NURSES REGISTRY, INC., and

HARRY DORVILIER a/k/a HARRY

DORVILIBN,

Defendants.

07 Civ. 4672 (CPS) (MDG)

CONSENT TO JOIN

COIJ.RCTIVE ACTION

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS BY JULY 15,2009

To: Clerk of the Court

Eastern District of New York

225 Cadman Plaza East

Brooklyn, New York 11201

I was employed by Harry's Nurses Registry, Inc. and/or Harry Dorvilier on or after November7, 2004. I understand tWs suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by LevyDavis & Maher, LLP (retainer agreement on file at the above address) and to be boimd by anysettlement of this action or adjudication of the Court.

of peg'ury that the foregoing is true and correct.

Printed Name

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Case 1:07-cv-04672-CPS-MDG Document 79 Filed 07/17/09 Page 1 of 3

LEVY DAVIS & MAKER, LLPJonathan A. Bernstein (JB 4053)

-Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, New York 10006(212) 371-0033

UNITED STATES DISTRICT COURTEASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

Plaintiff,

- against -

HARRY'S NURSES REGISTRY, INC., and

HARRY DORVILIER a/k/a HARRY

DORVILIEN,

Defendants.

07 Civ. 4672 (CPS) (MDG)

CONSENT TO JOIN

rOT T.ECTIVE ACTION

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS BY.JULY IS. 2009

To: Clerk of the Court

Eastern District of New York

225 Cadman Plaza East

Brooklyn, New York 11201

I was t mployed by Harry's Nurses Registry, Inc. and/or Harry Dorvilier on or after November7, 2004. I understand this suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by LevyDavis & Maher, LLP (retainer agi-eement on file at the above address) and to be bound by anysettlement of this action or adjudication of the Court.

I declare under penalty of peijury that the foregoing is true and correct.

Signature

M A A VPrinted Name

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Case 1:07-cv-04672-CPS-iVIDG Document 80 Filed 07/24/09 Page 1 of 1

LEVY DAVIS & MAKER, LLPJonathan A, Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, h ew York 10006(212) 371-0033

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

Plaintiff,

- against ■

HARRY'S NURSES REGISTRY, INC., and

HARRY DORVILIER a/k/a HARRY

DORVILIEN,

Defendants.

07 Civ. 4672 (CPS) (MDG)

CONSENT TO JOIN

COLLECTIVE ACTION

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS BY JULY IS. 2009

To: Clerk of the Court

Eastern District of New York

225 Cadman Plaza East

Brooklyn, New York 11201

Iwas employed byHarry's Nurses Registry, Inc. and/or Harry Dorvilier on or after November7, 2004. I understand this suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by LevyDavis & Maher, LLP (retainer agreement on file at the above address) and to be bound by anysettlement of this action or adjudication of the Court.

lare under penalty of pajury (hat the foregoing is true and correct.

Signa'tfife Date

Printed Name

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Case 1:07-cv-04672-CPS-MDG Document 72 Filed 06/26/2009 Page 1 of 1

LEVY DAVIS & MAHER, LLP

Jonathan A. Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, New York 10006(212)371-0033

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLB, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

Plaintiff,

- against

HARRY'S NURSES REGISTRY, INC., and

HARRY DORVILIER a/k/a HARRY

DORVILIEN,

Defendants.

07 Civ. 4672 (CPS) (MDG)

CONSENT TO JOIN

COTXECTIVE ACTION

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS BY JULY15.2009

To: Clerk of the Court

Eastern District of New York

225 Cadman Pla2a East

Brooklyn, New York 11201

I was employed by Harry's Nurses Registry, Inc. and/or HarryDorvilier on or after November7, 2004. I understand this suit is being brouglit under the Federd Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by LevyDavis & Maher, LLP (retainer agreement on file at the above address) and to be bound by anysettlement of his action or adjudication of the Court.

I declare under penalty of perjury that the foregoing is true and correct.

CthsL.

Signature ^

Printed Name

Date

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LEVY DAVIS & MAHER, LLP

Jonathan A. Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, New York 10006

(212)371 -0033

Dear Attorn ;y,

Haity's Nurse's Registry. Please

Thank You, ^«SS«&rfnwDtJSff

am not a participant in the lawsuit againstme from the list.

■«// 010

PLAINTIPFHip

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LEV.Y DAVIS & MAKER, LLPJonathan A. Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, New York 10006(212) 371 -0033

Dear Attorney,

I / ^ ' j am not a participant in the lawsuit againstHarry's Nurse's Registry. Please remove me from the list.

Thank You,

KAINTIFFm

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Page 10: Si^ature - harryhomecare.comharryhomecare.com/wp-content/uploads/2019/03/... · -^vf\ O CLc5 ^ "Qbs.CvX-'z FRANK M. PELLICCIONE Notary Public, State of New York Registration #01PE6068770

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FRANK M. PELLICCIONENotary Public, State of New York

Registration #01PE6068770Qualified In Nassau CountyMy Commission Expires Jan. Jd, 20 fQ

PLAINTIFF'S

r^i

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Page 12: Si^ature - harryhomecare.comharryhomecare.com/wp-content/uploads/2019/03/... · -^vf\ O CLc5 ^ "Qbs.CvX-'z FRANK M. PELLICCIONE Notary Public, State of New York Registration #01PE6068770

Case 1:07-cv-04672-CPS-MDG Document 71 Filed 06/19/2009 Page 1 of 3

LEVY DAVIS & MAKER, LLP

Jonathan A. Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, N w York 10006(212)371-0033

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

Plaintiff,

- against -

HARRY'S NURSES REGISTRY, INC., andHARRY DORVELIER a/k/a HARRY

DORVIUrEN.

Defendants.

07 Civ. 4672 (CPS) (MDG)

CONSENT TO JOIN

Collective action

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS BY JULY IS, 2009

To: Clerk of the Court

Eastern District of New York

225 Cadman Plaza East

Brooklyn, New York 11201

I was employed by Harry's Nurses Registry, Inc. and/or Harry Dorvilier on or after November7, 2004. I understand this suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuitj to be represented by LevyDavis & Maher, LLP (retainer agreement on file at the above address) and to be bound by anysettlement of this action or adjudication of the Court.

I declare under penalty of peijury that the foregoing is true and correct.

Date ^J 7 Mo ̂

PrinteWlame

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Case 1:07 cv-04672-CPS-MDG Document 71 Filed 06/19/2009 Page 2 of 3

LEVY DAVIS & MAKER, LLPJonathan A. Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, New York 10006(212) 371-0033

UNITED STATES DISTRICT COURTEASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

Plaintiff,

- against -

HARRY'S NURSES REGISTRY. INC., and

HARRY DORVILIER a/k/a HARRYDORVILIEN,

Defendants.

07 Civ. 4672 (CPS) (MDG)

CONSENT TO JOIN

COLLECTIVE ACTION

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVEADDRESS BY JULY] a. 2009

To: Clerk of the Court

Eastern District of New York

225 Cadman Plaza East

Brooklyn, New York 11201

Iwas employed by Harry's Nurses Registry, Inc. and/or Harry Dorvilier on or after November7, 2004. I understand this suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by LevyDavis & Maher, LLP (retainer agreement on file at the above address) and to be bound by anysettlement of this action or adjudication of the Court.

Signm

I decUre under penalty^!perjury that the foregoing is true.and correct.

Cl /Zlo^

i ueci-re unaer penalty or perjury tnat tJ

iid^-ondA mhuiTn

Printed Name

dorr^Date

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Case 1:07-cv-04672-CPS-MDG Document 71 Filed 06/19/2009 Page 3 of 3

LEVY DAVl j & MAKER, LLP

Jonathan A, Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, New York 10006(212) 371-0033

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

Plaintiff,

- against -

HARRY'S NURSES REGISTRY, INC., and

HARRY DORVILIER a/k/a HARRY

DORVILIEN,

Defendants.

07 Civ. 4672 (CPS) (MDG)

CONSENT TO JOIN

COLI,ECTIVE ACTION

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS BY JULY 15. 2009

To: Clerk of the Court

Eastern District of New York

225 Cadman Plaza East

Brooklyn, New York 11201

I was employed by Harry's Nurses Registry, Inc. and/or Harry Dorvilier on or after November7, 2004. I understand tWs suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by LevyDavis & Maher, LLP (retainer agreement on file at the above address) and to be bound by anysettlement of this action or adjudication of the Court.

I declare under penalty of pequry that the foregoing is true and correct.

Signature Date ' *

Printed Name !

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Case 1:07-cv-04672-CPS-MDG Document 70 Filed 06/12/2009 Page 1 of 1

LEVY DAVIS & MAKER, LLPJonathan A. Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway Ninth FloorNew York, New York 10006(212)371-0033

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

X

Plaintiff,

- against -

HARRY'S NURSES REGISTRY, INC., and

HARRY DORVILIER a/k/a HARRY

DORVILIEN,

Defendants.

07 Civ. 4672 (CPS) (MDG)

CONSENT TO JOIN

COLLECTIVE ACTION

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS BY JULY 15.2009

■X

T0: Clerk of the CourtEastern District of New York225 Cadman Plaza EastBrooklyn, New York 11201

Iwas employed by Harry'sNurses Registry, Inc. and/orHairy Dorvilier on or after November7, 2004. I understand this suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by LevyDavis & Maher, LLP (retainer agreement on file at the above address) and to be bound by anysettlement of this action or adjudication of the Court.

I declare under penalty of peijuiy that the foregoing is true and correct.

MajL- ffloJdsll,Signature

MahSsTEPrinted Name

Date if

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Case 1:07-cv-04672-CPS-MDG Document 69 Filed 06/05/2009 Page 1 of 2

LEVY DAVIS & MAKER, LLP

Jonathan A. Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, New York 10006(212)371-00,: J

LINITED STATES DISTRICT COURT

EASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

•X

Plaintiff,

- against

HARRY'S NURSES REGISTRY, INC., and

HARRY DORVILIER a/k/a HARRY

DORVILIEN,

Defendants.

07 Civ. 4672 (CPS) (MDG)

CONSENT TO JOIN

rOIJRCTIVE ACTION

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS BY JULY 15. 2009

To: Clerk jf the Court

Eastern District of New York

225 Cadman Plaza East

Brooklyn, New York 11201

I was employed byHarry's Nurses Registry, Inc. and/or Harry Dorvilier on or after November7, 2004. I understand this suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by LevyDavis & Maher, LLP (retainer agreement on file at the above address) and to be bound by anysettlement of this action or adjudication of the Court.

I declare under penalty of peijury that the foregoing is true and correct.

Signal Date

2_

A J/s ^ycaJ, y CzjPrinted Name

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Case 1:07-. v-04672-CPS-MDG Document 69 Filed 06/05/2009 Page 2 of 2

LEVY DAVIS & MAKER, LLPJonathan A. Bernstein (JB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, New York 10006(212) 371-0033

UNITED states DISTRICT COURT

EASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

Plaintiff,

against -

HARRY'S NURSES REGISTRY, INC., and

HARRY DORVILIER a/k/a HARRY

DORVDLIEN,

Defendants.

07 Civ, 4672 (CPS) (MDG)

CONSENT TO JOIN

COLLECTIVE ACTION

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS BY.JULY 15. 2009

To: Clerk of the Court

Eastern District of New York

225 Cadman Plaza East

Brooklyn, New York 11201

I was employed by Harry's Nurses Registry, Inc. and/or Harry Dorvilier on or after November7, 2004. I understand this suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by LevyDavis & Maher, LLP (retainer agreement on file at the above address) and to be bound by anysettlement of this action or adjudication of the Court.

I decl. re under penalty of perjury that the foregoing is true and correct.

Signature

Printed Name

do

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Case 1:07-cv-04672-CPS-MDG Document 66 Filed 05/22/2009 Page 1 of 2

LEVY DAVir & MAKER, LLPJonathan A. Bernstein (IB 4053)Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, New York 10006(212)371-0033

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

Plaintiff,

- against -

HARRY'S NURSES REGISTRY, INC., and

HARRY DORVILIER a/k/a HARRY

DORVILIEN,

Defendants.

07 Civ. 4672 (CPS) (MDG)

CONSENT TO JOIN

COLLECTIVE ACTION

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS BY JULY15. 2009

To: Clerk of the Court

Eastern District of New York

225 Cadman Plaza East

Brooklyn, New York 11201

I was employed by Harry's Nurses Registry, Inc, and/or Harry Dorvilier on or after November7, 2004. I understand this suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by LevyDavis & Maher, LLP (retainer agreement on file at the above address) and to be bound by anysettlement of this action or adjudication of the Court.

I declare under penalty of pequiy that the foregoing is true and correct.

Signatureshe-fo-i

Date

Printed Name

Page 19: Si^ature - harryhomecare.comharryhomecare.com/wp-content/uploads/2019/03/... · -^vf\ O CLc5 ^ "Qbs.CvX-'z FRANK M. PELLICCIONE Notary Public, State of New York Registration #01PE6068770

Case 1:07"Cv-04672-CPS-MDG Document 66 Filed 05/22/2009 Page 2 of 2

LEVY DAVIS & MAKER, LLPJonathan A. Bernstein (JB 4053)

Attorneys for Plaintiff29 Broadway, Ninth FloorNew York, New York 10006

(212) 371-0033

UNITED STATES DISTRICT COURT

EASTERN DISTRICT OF NEW YORK

CLAUDIA GAYLE, Individually, On Behalfof All Others Similarly Situated and as ClassRepresentative,

Plaintiff,

against -

HARRY'S NURSES REGISTRY, INC., and

HARRY DORVELIER a/k/a HARRY

DORVILIEN,

Defendants.

07 Civ. 4672 (CPS) (MDG)

CONSENT TO JOIN

COLLECTIVE ACTION

THIS FORM MUST BE

RETURNED TO PLAINTIFFS'

ATTORNEYS AT THE ABOVE

ADDRESS BY JULY is: 2009

To: Clerk of the Court

Eastern District of New York

225 Cadman Plaza East

Brooklyn, New York 11201

I was employed byHarry's Nurses Registry, Inc. and/or Harry Dorvilier on or after November7, 2004, I un 'erstand this suit is being brought under the Federal Fair Labor Standards Act forunpaid overtime. I consent to become a party plaintiff to this lawsuit, to be represented by LevyDavis & Maher, LLP (retainer agreement on file at the above address) and to be bound by anysettlement of this action or adjudication of the Court.

I declare imder penalty of penury that the foregoing is true and correct.

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'fmE Bua/Ce l4ijVTe»^inted Name

Date